The present invention relates to the processing of insurance-related information. More particularly, the present invention relates to point-of-care devices, methods, and systems for verifying insurance eligibility and handling settlement transactions.
The process for health care providers to verify a patient's insurance eligibility and to settle claims is ripe for improvement. Prior to providing care, providers typically contact payers to verify whether a patient is actually covered under a particular plan, what specific procedures, lab tests, and the like are covered under the plan, and whether dependents are covered. In most present cases, providers either type patient information into a web-based or batch-based system or call voice IVR (interactive voice response) systems to verify a patient's coverage. Once eligibility is verified, the co-pay amount may be determined and the patient may be expected to make payment prior to receiving care. This often requires the provider to process a financial transaction through a separate procedure. This process is costly, time consuming, and error prone, often resulting in delayed payment of claims due to eligibility issues.
Once care is provided, providers often file claims on behalf of patients and await payment from the coverage provider. If the patient paid a deductible, co-payment, or an initial or other payment, the patient also may complete claim forms and return them to a provider or third party administrator. Further, if the patient received a prescription from the doctor, the patient and/or a pharmacist also may complete claim forms for reimbursement for pharmaceuticals and/or over-the-counter medications, which, in some cases, are now reimbursable under flexible spending accounts (FSAs), health reimbursement accounts (HRAs) and/or other types of healthcare and/or stored value balances. Each of these processes is administratively intensive; collectively they become overwhelming for some individuals for even a single doctor visit.
For the foregoing reasons, there is a need for a point-of-care insurance eligibility verification and settlement terminal and methods of using such. Hence, among a number of other advantages apparent from the following description, the present invention addresses these and other issues related to health care eligibility verification and settlement by providing systems, devices, and methods for addressing the aforementioned limitations.